International Journal of Physiotherapy and Research,

Int J Physioth Res 2013 (3):71-76. ISSN 2321-1822

Original Article

EFFECTIVENESS OF INTERMITTENT PELVIC TRACTION VS

INTERMITTENT PELVIC TRACTION WITH SELF NEURAL
MOBILIZATION ON LOW BACK PAIN A COMPARATIVE STUDY
S.Dinesh Kumar, MPT Sports
Professor, Madha college of Physiotherapy, Kundrathur.

ABSTRACT
Background: Low Back pain is common clinical condition encountered in a day to day Physiotherapy practice.
Very few author has so far documented the efficacy of self neural mobilization ,but no literature available SNM
during Intermittent Pelvic Traction. Hence to find out the effect of same this study is done. Materials and
Methods: Pre & Post Test Experimental Design, Physiotherapy Out Patient Department, MADHA Medical College Hospital and Research Centre, Kundrathur 600069. Participants and Intervention: 30 subjects, Two IPT
protocol (with and without Self Neural Mobilization) Procedure: 30 subjects were randomly sampled and divided into 2 groups (Group A & B). Group A received only IPT (20 minutes, 20 seconds Hold time, 5 secondsrest time) whereas Group B received IPT and self Neural Mobilization( Active Ankle Plantar & Dorsi flexion
movements) (only during Rest time). Results: Were analyzed with Visual Analogue Scale, Oswestry Disability
Index, when comparing the Pre test and Post test values of VAS and ODI there is significant difference at 95%
interval (P < 0.05). Conclusion: Self Neural Mobilization during Intermittent Pelvic Traction is effective in
reducing Low back pain.
KEY WORDS: INTERMITTENT PELVIC TRACTION; SELF NEURAL MOBILIZATION(SNM); VAS & ODI.

Address for correspondence: S.Dinesh Kumar, Professor, Madha College of Physiotherapy,

Kundrathur, Tamil Nadu- 600069 India. Email: physiodinesh80@gmail.com.

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International Journal of Physiotherapy and Research

ISSN 2321- 1822
www.ijmhr.org/ijpr.html
Published: 11 August 2013

Received: 25 June 2013

Accepted: 05 July 2013

The use and description of neural mobilization

to influence the mechanical properties of
Lumbar traction is one of the oldest treatment
peripheral nerve gained popularity from the late
modality for LBP. Hippocrates described lumbar
1970s through1980s.
traction in various forms has been used for
centuries and continues to be used in today However the underlying mechanism associated
clinical environment. Recent clinical studies, with clinical improvements following
systematic review of literature, and evidence neuralmobilization remain unclear.
based guidelines have concluded that
preponderance of evidence fails to support the There are many theories have been postulated
lumbar traction as an effective treatment for including physiological effects (removal of
intraneural edema) central effects (reduction of
patients with LBP.
dorsal horn and supraspinal sensitization) and
Still there are literature supports the positive mechanical effects (enhanced nerve excursion)
effect of traction on LBP; some are reported the
lack of methodological design of previous Many studies examined the influence of neural
research, have made the literature regarding mobilization exercises on nerve mechanics in
cadaver.
lumbar traction still under debate.

INTRODUCTION

Int J Physioth Res 2013(3):71-76.

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71

Dinesh Kumar S, Effectiveness of intermittent pelvic traction vs intermittent pelvic traction with self neural mobilization on low back pain
a comparative study.

Copiers et al examined the median nerve

excursion between different types of nerve
gliding exercises (including sliders and
tensioners) Sliders utilizes combination of joint
movements to encourage peripheral nerve
excursion by increasing elongation at one end
of nerve bed, thereby creating tension in the
nerve from that end while simultaneously
releasing tension from other and of nerve. In
doing so excursion is promoted without
increasing nerve tension.
Sliders produce greater amount of median nerve
excursion compared to tensioners.It has also
been shown that significantly less nerve
excursion occurred during nerve gliding exercises
initiated from one end of nerve bed using a single
joint movement compared to sliders.
Neuralmobilisation exercises derived from
neurodynamic test such as slump test, SLRtest
have been advocated in clinical texts and as a
result of published clinical trials.
Neurodynamic mobilization technique often
used clinically to restore nerve mobility and
decrease pain.

common clinical condition encountered in a day

to day Physiotherapy practice. NO author has so
far documented the efficacy of SNM (Active
ankle movements) during Intermittent Pelvic
Traction. Hence to find out the effect of same
this study is done.

MATERIAL AND METHODS

A comparative Study was conducted with 30
subjects by simple random sampling at
MADHA Physiotherapy Clinic, MADHA Medical
College, Hospital And Resesearch centre,kovur,
Thandalam.
Inclusion Criteria7: Pain and/or paresthesia in
the lumbar spine with a distribution of
symptoms that has extended distal to the gluteal
fold on at least one lower extremity within the
past 24 hours. Oswestry disability score of at
least 20%, Age at least 18 years and less than 60
years, At least one of the following signs of nerve
root compression:
1. Positive ipsilateral or contralateral straight leg
raise test (reproduction of leg symptoms with
straight leg raise < 70 degrees)

2. Sensory deficit to pinprick on the ipsilateral

Richard F.Ellis PT Phd has demonstrated in vivo lower extremity
Measurement of sciatic nerve excursion in 3. Diminished strength of a myotome (hip
normal healthy participants during different flexion, knee extension, ankle dorsiflexion, great
types of neural mobilization exercises.26
toe extension, or ankle eversion) of the
Patients with signs of nerve root irritation
represent a sub-group of those with low back
pain who are at increased risk of persistent
symptoms and progression to costly and invasive
management strategies including surgery.
A period of non-surgical management is
recommended for most patients, but there is
little evidence to guide non-surgical decisionmaking. We conducted a preliminary study
examining the effectiveness of a treatment
protocol of mechanical traction with Self
NeuralMobilization(SNM) for patients with low
back pain and signs of nerve root irritation.
To observe and evaluate the clinical effects of
Intermittent Pelvic Traction with Self Neural
Mobilization( Active Ankle Dorsi and Plantar
flexion) on Low Back Pain.Low Back pain is
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ipsilateral lower extremity

4. Diminished lower extremity reflex (Quadriceps
or Achilles) of the symptomatic lower extremity
Exclusion Criteria7: Red flags such as , tumor,
metabolic diseases, RA, osteoporosis, spinal
compression fracture, prolonged history of
steroid use, etc. central nervous system
involvement such as cauda equina syndrome
(i.e., loss of bowel/bladder control or saddle
region paresthesia) or the presence of
pathological reflexes (i.e., positive Babinski)
complete absence of low back and leg symptoms
when seated, Recent surgery (< 6 months) to the
lumbar spine or buttocks, Recent (< 2 weeks)
epidural steroid injection for low back, Current
pregnancy, Inter vertebral Disc Prolapse, Inability
to comply with the treatment schedule.
72

Dinesh Kumar S, Effectiveness of intermittent pelvic traction vs intermittent pelvic traction with self neural mobilization on low back pain
a comparative study.

Materials: Traction Unit8. With intermittent

mode for 20 minutes durations followed by 20
seconds and 5 Seconds Hold and Rest times
respectively.
Participants: Subjects eligible for the study if
they were aged between 18 and 60years and
must have reported LBP ,with the presence of
associated lower extremity pain/paraesthesia
that had an average intensity of greater than 4
on VAS.In addition ,all subjects had to have a
score of greater than 20% on the ODI
questionnaire.

After unlocking the traction table the traction

force was slowly increased from 30 % of total
body weight until the patient indicated a distinct
but tolerable pulling. The maximum force used
was set at 40% of the total body weight. Group
B ( 15 subjects ) received IPT (20 minutes, 20
seconds - Hold time, 5 seconds - rest time).The
patients in Group B advised to do active ankle
dorsi and plantar flexion during the rest time at
their own speed. Post test measurements taken
after the Intervention. Measurement Tools:
Visual analogue scale (VAS) 10, Oswestry disability
index (ODI) 11

Subjects screening and intake measures Prior RESULTS

to the admission to the study subjects
underwent a screening procedure to verify the Comparison of VAS between Group A and Group
entry and exclusion criteria. Subjects who met B(Table-1):
Std
the entry and exclusion criteria, and provided
Significant
VAS
Type
Mean
SD
Error t-value
level
written informed consent, were enrolled in the
Mean
Pre
test
1
7.37
0.65
0.13603
study. At this time the subjects completed pre
Group A
1.522 0.139(NS)
Post test
7.3
0.845
test measurements. Each subject was scheduled
Pre test
2
7
1
0.2146
for 15 days of IPT of 20 minutes.
Group B

21

Interventions Patients were allowed to

continue with their regular pain medication,but
other co-interventions (eg injections
,massage,exercises,physical modalities)were not
allowed.The treatment series could be ended if
a patient was free of symptoms before the last
session or if the pain increased during two
consecutive treatment sessions.After the
patients lay down on the traction table in supine
position ,the canvas traction braces were
attached around the iliac crest and the lower
thoracic cage.
In the Group A the patients were explicitly asked
to tell when they felt distinct pulling from the
braces. After unlocking the traction table the
traction force was slowly increased from 30 %
of total body weight until the patient indicated
a distinct but tolerable pulling. The maximum
force used was set at 40% of the total body
weight. Group A ( 15 subjects ) received only IPT
(20 minutes, 20 seconds - Hold time, 5 seconds rest time)
In the Group B the patients were explicitly asked
to tell when they felt distinct pulling from the
braces.
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Post test

14.929

0.845

0.000***

*** :p<0.05

The above table reveals the mean, standard

deviation, independent t-test and significant pvalue of VAS between pre test and post test in
Group A and Group B.
The mean value of Group B shows statistically
significant result between the pre test and post
test(p<0.05).
Comparison of VAS between Group A & B
(Graph -1):

8
6

7.377

7
5

Pre - Test
Post - Test

2
0

0
Group A Group B

73

Dinesh Kumar S, Effectiveness of intermittent pelvic traction vs intermittent pelvic traction with self neural mobilization on low back pain
a comparative study.

Comparison of ODI between Group A &

B(Table-2):
ODI

Type
Pre test

Group A

Post test
Pre test

Group B

Post test

Std
Significant
Error t-value
level
Mean
59.6 8.626 0.13603
1.898 0.068(NS)
51.33 14.495

Mean

SD

44.27

9.938 0.2146

18.53

7.726

7.917

0.000***

***:p<0.05

The above table reveals the mean, standard

deviation, independent t-test and significant pvalue of ODI between pre test and post test in
Group A and Group B.
The mean value of Group B shows statistically
significant result between the pre test and post
test (p<0.05).
Comparison of ODI between Group A and
Group B(Graph-2).
70
60

59.5
51.33

50

44.27

40
Pre - Test

30
18.53

20
10

0
Group A

Group B

When comparing the Pre test and Post test

values of VAS and ODI there is significant
difference between the two scales at 95%
( P<0.05 ) in Group B than in Group A.

DISCUSSION

Peripheral nerves straighten and stretch in order

to accommodate increases in bed length during
joint movements23. The pain relief may also due
to the Strain of Peripheral Nerves during Ankle
movements. However it can be confirmed only
by the Diagnostic Ultra sound which shows the
neural mobility.22,25
The IPT along with active ankle movement nerve
mobility and stress/strain characteristics in lower
extremities improved; and mechanisms and
consequences of trauma on nerve
microcirculation as well as influence on
axoplasmic and lymphatic flow within peripheral
nerve identified. Mathew carrol et al quantified
the degree of longitudinal tibial nerve excursion
as the ankle moved from dorsiflexion to plantar
flexion which supports the study result.
Larissa sale teles versa et al conducted study in
leprosy patients who are undergoing the
technique of neural mobilization had
improvement in electromyography function and
muscle strength, reducing disability degree and
pain. Physical therapy management of
peripheral nerve dysfunction as reported by
Elvey and Butler is reviewed. Guidelines for
appropriate principles of clinical examination and
treatment are outlined as well as possible areas
for future clinical research
It is interesting to note that even though studies
stating the lack of efficiency of Lumbar traction15
for LBA, it is still a widely used modality in a
clinical set up.14
Hence, it must be emphasized that Spinal
traction is only a part of the total management
treatment regimen, which includes other forms
of Physical therapy. Without a total management
program, Spinal traction, like many other
methods has little chance of long range benefit.2

The results suggested in Group A with Only IPT The results suggested this approach may be
co-relates with previous studies which concluded effective, particularly in a more specific subthat traction is NOT effective (P < 0.05) in LBA.13 group of patients. The aim of this study will be
to examine the effectiveness of treatment that
Where as in Group B, IPT with SNM (Active Ankle includes traction for patients with low back pain
Movements) there is a decrease in Pain and ODI. and signs of nerve root irritation, and within the
The underlying causes for this may be the pre-defined sub-group.
sensitization of Nerve root pain by performing
Active DF.14
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74

Dinesh Kumar S, Effectiveness of intermittent pelvic traction vs intermittent pelvic traction with self neural mobilization on low back pain
a comparative study.

Traction therapy effectively mitigates pain,

enhances joint flexibility, and improves the
quality of life of patients with lumbar pain. The
equipment required to administer intermittent
pelvis traction is simple and treatment technique
is simpler to perform by the patient themselves.

CONCLUSION
Self Neural Mobilization (Active Ankle dorsi &
plantar flexion movements) during Intermittent
Pelvic Traction is effective in reducing LBP with
radiculopathy. However this requires
confirmation by further investigation.
Limitations: Present study is limited in the
fallowing areas: study was conducted in short
duration, no control group, short duration
symptoms, no radiological examination.
Further recommendations: Similar study can be
carried out with the Larger sample group, study
design shift to prospective, Shoe modification,
different age group, Combination therapies such
as UST and Cryotherapy, Iontophoresis, Moist
heat.

ACKNOWLEDGEMENT
I thank Almighty first for the successful
completion of this study. And I thank Principal,
VicePrincipal Madha college of Physiotherapy
and my colleagues who are giving constant
support and encouragement. Never forget the
unconditional help from my students, friends
and my family members who are always with
my all endeavors. I must Thank all my patients
for their kind co-operation for this study.

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How to cite this article:

Dinesh Kumar S, Effectiveness of intermittent
pelvic traction vs intermittent pelvic traction
with self neural mobilization on low back pain
A comparative study. Int J Physioth Res

2013;03:71-76.

Int J Physioth Res 2013(3):71-76.

ISSN 2321-1822

76